1. Nutritional Supplements An Issue Everyone Needs to Know

2. What is a Nutritional Supplement? o Product intended to supplement the diet and contain one or more dietary ingredients: o Intended to be taken by mouth o In the form of capsule, powder, softgel, gelcaps, tablet, liquid, etc. o Not represented for use as conventional food

3. Major Issue With Nutritional Supplements o The Dietary Supplement Health and Educational Act of 1994 allows manufactures to market dietary supplement products without being reviewed for safety and effectiveness. (FDA, 2015)

4. Laws on Nutritional Supplements o No requirement for efficacy o No requirement for safety

5. Learn More About Nutritional Supplement Issues o Peer reviewed Journals Journal of Nutrition and Dietary Supplements Journal of Dietary Supplements Dietary Supplements and The American Journal of Clinical Nutrition Clinical Nutrition Supplements Journal o Dietary Supplement Fact Sheets o Ask your health care provider

6. Learn More (continued)  Federal Government Information Sources on Dietary Supplements o National Institutes of Health Office of Dietary Supplements National Center for Complementary and Alternative Medicine National Library of Medicine Medline Plus PubMed NIH Health Information o U.S. Food and Drug Administration o Federal Trade Commission o U.S. Department of Agriculture o U.S. Department of Health and Human Services o Nutrition.gov o Dietary Supplement Label Database

7. Recommended Educational Resources o Educational Models Online Training in Dietary Supplements for Health Care Professionals http://www.bu.edu/fammed/otds/ Online Botanical Medicine Model http://www.csh.umn.edu/education/online-learining-module-resources/online-learining-modules Online Lectures Clinically Relevant Herb-Drug Interactions – Lecture by Dr. Bill Gurley https://www.nccih.nih.gov/research/blog/Gurleylecture Network Pharmacology and Natural Products Webinar https://www.nccih.nih.gov/research/blog/network-pharmacology-webinar o Newsletters ODS Update Newsletter The Scoop Newsletter https://ods.od.nih.gov/News/ODS_ListServ.aspx o Articles Some Imported Dietary Supplements and Nonprescription Drug Products May Harm You http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm466588.htm

8. Safety and Effectiveness Recommendations o When searching for supplements use noncommercial sites. o It is important to ensure that you obtain information form reliable sources. o Watch out for false statements. o Be aware that the term “natural” doesn’t always mean “safe”. o Supplements should not replace prescribed medications or the variety of foods important to a healthful diet.

9. Safety and Effectiveness Recommendations Cont. o Ask your healthcare provider for help in distinguishing between reliable and questionable information. o Remember, safety first. o Eat variety of foods that are important to a healthy diet. o Be alert for unexpected side effects, especially when taking a new product. o If you have or had a serious reaction from a dietary supplement, let your health care provider know.

10. Safety and Effectiveness Recommendations Cont. o Report problems to FDA in either of these ways: o Contact Consumer Complaint Coordinator in your area. o File a safety report online through the Safety Reporting Portal. o Look for products that have been quality tested by U.S. Pharmacopeia, ConsumerLab.com, and NSF International. o Check the label.

11. Precautions o Don’t take dietary supplements is pregnant or nursing. o May have interactions with other medications o Some dietary supplements can have unwanted effects during surgery. o Some dietary supplements are known to be dangerous. o More isn’t always better. o Don’t substitute dietary supplements for medication

12. References FDA. (2015, November). Retrieved from U.S. Food and Drug Administration: http://www.fda.gov/Food/DietarySupplements/UsingDietaryS upplements/ucm109760.htm http://www.fda.gov/Food/DietarySupplements/UsingDietaryS upplements/ucm109760.htm NCCIH. (2009, February). Using Dietary Supplements Wisely. Retrieved May 13, 2016, from NIH National Center for Complementary and Integrative Health: https://nccih.nih.gov/health/supplements/wiseuse.htm https://nccih.nih.gov/health/supplements/wiseuse.htm

13. References Cont. ODS. (2011, June). Dietary Supplements: What You Need to Know. Retrieved May 13, 2016, from National Institutes of Health Office of Dietary Supplements: https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeed ToKnow.aspx https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeed ToKnow.aspx ODS. (2013, July 1). Frequently Asked Questions. Retrieved May 16, 2016, from National Institutes of Health Office of Dietary Supplements: https://ods.od.nih.gov/Health_Information/ODS_Frequently _Asked_Questions.aspx#Information https://ods.od.nih.gov/Health_Information/ODS_Frequently _Asked_Questions.aspx#Information

14. References Cont. Paul, M. W., & Smith, M. (2016, April). Dietary Supplements: The Smart and Safe Use of Vitamins and Supplements. Retrieved May 16, 2016, from HelpGuide.org: http://www.helpguide.org/articles/healthy-eating/dietary- supplements.htm http://www.helpguide.org/articles/healthy-eating/dietary- supplements.htm